Health inspection·February 15, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, policy review and interviews the facility failed to ensure Resident #64 received comprehensive and individualized care to prevent/treat constipation. This affected one resident (Resident #64) of two residents reviewed for bowel and bladder management. The census was 72. Residents Affected - Few Findings included: Review of the medical record revealed Resident #64 was admitted to the facility on [DATE]. Diagnoses included respiratory failure, chronic obstructive pulmonary disease, alpha-1-antitrypsin deficiency, emphysema, anxiety disorder, protein-calorie malnutrition, dehydration, constipation (06/28/23) and hypertension. Review of the plan of care dated 07/05/23 revealed Resident #64 had bowel incontinence related to side effects of medication. She had no incontinence pattern identified on the three-day bowel and bladder tracker. Interventions included to observe for a pattern of incontinence and initiate toileting schedule if indicated, provide a bedpan or bedside commode, provide loose fitting and easy to remove clothing, provide peri care after each incontinent episode and inspect her skin for irritation. The resident did not have a care plan related to constipation. Review of the physician's order dated 07/12/23 revealed Resident #64 had an order to give prune juice for constipation. The order did not specify when to give the prune juice or how often. Review of the Bowel and Bladder assessment dated [DATE] revealed Resident #64 was continent of bowel. Further review of the medical record revealed the resident was hospitalized from [DATE] through 12/27/23 after having difficulty breathing and the resident requested to be evaluated in the emergency room. Upon the resident's return, the resident began to experience lack of bowel movements and complaints of abdominal pain. Review of the physician's order dated 12/27/23 revealed Resident #64 had an order to give milk of magnesia (MOM) 30 milliliters (ml) once daily per bowel protocol if no bowel movement (BM) in three consecutive days; give a bisacodyl suppository (laxative) 10 milligrams (mg) one daily at bedtime if no bowel movement eight hours after MOM administration. Review of the physician's order dated 12/28/23 revealed Resident #64 had an order to give Colace (stool softener) 100 mg every 24 hours as needed for constipation. Review of the Significant Change Minimum Data Set assessment dated [DATE] revealed Resident #64 had intact cognition. She was occasionally incontinent of bladder, always continent of bowel, and required partial assistance with transfers and toileting. Review of the nursing assistant documentation for resident bowel movement tracking from 12/27/23 to 01/14/24 revealed the resident had a small bowel movement on 12/28/23 and no BM documented from 12/29/23 to 01/12/24. Resident #64 had two medium and one small bowel movements on 01/13/24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365152 If continuation sheet Page 2 of 7 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Schoenbrunn Healthcare 2594 East High Avenue New Philadelphia, OH 44663 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Medication Administration Record (MAR) for January 2024 revealed Resident #64 was given Colace 100 mg on 01/02/24 and 01/07/24 but the medication was ineffective. Review of the progress notes dated 01/08/24 at 4:41 P.M. revealed Resident #64 refused medication for constipation despite education of risks and benefits. Her abdomen was non-distended with hypoactive bowel sounds. (The progress note did not indicate what medication for constipation Resident #64 refused). Review of the progress note dated 01/12/24 at 3:35 P.M. revealed hospice was called in regards to Resident #64 not having a BM and refusing to take any oral medication to help alleviate it. Review of the progress notes dated 01/12/24 at 4:00 P.M. revealed Resident #64 was having trouble moving her bowels. She was stating to the nursing assistants she just wants the BM to fall out and not have to worry about going. She was offered Colace and refused stating she just wanted a little orange colored pill (bisacodyl). Review of the physician's order dated 01/12/24 revealed Resident #64 had an order to give bisacodyl five or 10 mg tablet once daily as needed for constipation. Review of the January Medication Administration Record (MAR) revealed the resident was administered bisacodyl on 01/12/24, which was ineffective, a bisacodyl 10 mg suppository on 01/13/24 and 01/15/24 which were effective. On 02/13/24 at 8:00 A.M. an interview with Resident #64 revealed she had been having trouble with constipation because the nurse (Licensed Practical Nurse #156) would not give her a Dulcolax (bisacodyl) pill when she asked for one. The resident stated she told the nurse she was having severe abdominal pain because she had not had a bowel movement since she had returned from the hospital, she was not sure how many days it had been. She stated the nurse brought in her MOM but she told the nurse she did not want it because it did not work for her. She stated the nurse just mumbled something to her, went out of the room, and never tried to give her anything else. She stated she got upset and called for the nurse to come back in her room. She stated she asked the nurse what she said, and the nurse told her they had a bowel protocol they must follow for constipation, and they could not just give her a bisacodyl. The resident stated she knew the MOM was not going to work fast enough so she did not want it and they would not give her anything else. She stated they had not done anything for a couple days and she was having severe abdominal pain. She stated she only refused the MOM but it was the only laxative the nurse offered. On 02/14/24 at 3:20 P.M. an interview with Regional Compliance Nurse #200 confirmed there was no documentation of Resident #64 having a BM from 12/29/23 to 01/12/24. Multiple attempts to reach LPN #156 were unsuccessful. Review of the facility policy titled, Bowel Management and Treatment, dated 04/03/17 revealed the purpose was to achieve control of bowel evacuation on a routine basis which may be indicated by an independent or assisted stool every two to three days to avoid constipation and prevent skin irritation. Residents who have not had a movement for three consecutive days would have the following protocol initiated unless the resident had individual orders specific to bowel management. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365152 If continuation sheet Page 3 of 7 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Schoenbrunn Healthcare 2594 East High Avenue New Philadelphia, OH 44663 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 1. The initial nurse receiving the Point Click Care Alert for the lack of bowel movement in three days would begin the following bowel protocol for the residents: Level of Harm - Minimal harm or potential for actual harm a. Assess for bowel sounds. Residents Affected - Few b. Administer 30 milliliters of milk of magnesia. c. If the resident refused the MOM, the nurse would notify the attending physician and document such on the MAR and nurse's notes. d. Documents on the MAR and in the nurse's notes when the resident had a BM and then the resident would be placed on a modified promotional bowel regimen. 2. The Medication nurse on the next shift would check the list upon beginning her shift and the following would be performed. a. Assess for bowel sounds. b. If the resident does not have a BM on the prior shift, after receiving MOM, the nurse would administer a suppository per the physician's orders. c. If the resident refused the suppository, the nurse would notify the attending physician and document such on the MAR and nurse's notes. d. Documents on the MAR and in the nurse's notes when the resident had a BM and then the resident would be placed on the modified promotional bowel regimen. 3. The medication nurse for the third consecutive/next shift would check the list at the start of her shift and the following would be performed. a. Assess bowel sounds. b. If the resident does not have a BM in the prior shift, after receiving the suppository, he nurse would administer an enema per physician's order. c. If the resident refused the enema, the nurse would notify the attending physician and document such on the MAR and nurse's notes. d. Documents on the MAR and in the nurse's notes when the resident had a BM and then the resident would be placed on the modified promotional bowel regimen. e. If the resident does not have a BM within one hour of receiving the enema, notify the attending physician for further instruction and document such in the MAR and in the nurse's notes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365152 If continuation sheet Page 4 of 7 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Schoenbrunn Healthcare 2594 East High Avenue New Philadelphia, OH 44663 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the medical record and interview with staff the facility failed to ensure Resident #10, #37 and #49 had physician ordered adaptive equipment for meals. This affected three residents (Resident #10, #37 and #49) of six residents reviewed for nutrition. The census was 72. Residents Affected - Few Findings included: 1. Review of the medical record revealed Resident #49 was admitted to the facility on [DATE]. Diagnoses included dysphagia, acute respiratory failure, proteins-calorie malnutrition, dementia, weakness, cerebral infarction, and paraplegia. Review of the physician's orders revealed Resident #49 had an order for a plate guard (a metal food bumper that clips onto a plate and makes scooping food onto utensils easier), dated 08/15/22. Observation on 02/13/24 at 8:15 A.M. revealed Resident #49 was in the atrium eating her breakfast. Her plate guard was not on her plate but was lying on the table. An interview at this time with State Tested Nursing Assistant (STNA) #100 stated she did not know why it was not on the resident's plate but she applied the plate guard to the resident's plate. Interview with Resident #49 revealed she had not removed the plate guard from her plate. 2. Review of the medical record revealed Resident #37 was admitted to the facility on [DATE]. Diagnoses included Parkinson's disease, dysphagia, dementia, diabetes, protein-calorie malnutrition, adult failure to thrive, and transient cerebral ischemic attack. Review of the physician's orders revealed Resident #37 had an order for a regular diet with a plate guard and grey weighted silverware dated 02/23/23. Observation on 02/13/24 at 5:20 P.M. revealed Resident #37 was sitting in her room eating her dinner meal. She did not have her plate guard on her plate but it was sitting off to the side, on the table. On 02/13/24 at 5:27 P.M. an interview with Licensed Practical Nurse (LPN) #164 confirmed Resident #37 did not have her plate guard on her plate as ordered. 3. Review of the medial record revealed Resident #10 was admitted to the facility on [DATE]. Diagnoses included end stage renal disease, diabetes, dependent on renal dialysis, legally blind, anxiety disorder, and glaucoma. Review of the physician's orders revealed Resident #10 had an order for a plate guard for all meals dated 09/20/23. Observation on 02/13/24 at 5:25 P.M. revealed a nursing assistant delivered the meal tray to Resident #10 and she had not placed the plate guard on his plate. She sat it off to the side with his lid to his plate. She did not ask him if he wanted the plate guard on or off his plate. On 02/13/24 at 5:28 P.M. an interview with Licensed Practical Nurse (LPN) #164 confirmed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365152 If continuation sheet Page 5 of 7 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Schoenbrunn Healthcare 2594 East High Avenue New Philadelphia, OH 44663 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0810 nursing assistant had not placed the plate guard on the plate of Resident #10. She stated he was blind and needed it on his plate. She also verified she had not asked him if he wanted it on his plate. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365152 If continuation sheet Page 6 of 7 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Schoenbrunn Healthcare 2594 East High Avenue New Philadelphia, OH 44663 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview and policy review the facility failed to accurately obtain and document resident weights. This affected one (Resident #20) of four residents reviewed for nutritional services. The facility census was 72. Findings include: Review of Resident #20's medical record revealed an admission date of 11/21/23 with diagnoses that included non-displaced fracture of right great toe, chronic obstructive pulmonary disease, diabetes mellitus, congestive heart failure and hypertension. Review of Resident #20's weights revealed a weight of 242 pounds upon admission on [DATE], 213.5 pounds on 11/28/23 (loss of 28.5 pounds in three days), 214.6 pounds on 12/11/23, 228 pounds on 01/15/24 (gain of 13.4 pounds in 34 days), 214.4 pounds on 01/30/24 (loss of 13.6 pounds in 15 days) and 237.0 pounds on 02/02/24 (gain of 22.6 pounds in three days). No evidence of any attempted re-weights to check for accuracy were noted. Weights were obtained by varying methods (sitting, standing, wheelchair and lift scale) and by various staff members. Review of nutritional notes revealed on 02/01/24 concerns related to possible weight error of 228 pounds on 01/15/24. A nutritional note on 01/18/24 indicated weekly weights were discontinued due to resident's request and refusal. Refusal of weights documented in nutritional notes on 01/06/24, 12/28/23 and 12/23/23. On 02/15/24 at 9:10 A.M. interview with Registered Dietician (RD) #201 verified there were concerns with accuracy of weights and no attempted re-weighs occurred to ensure accuracy. On 02/15/24 at 9:55 A.M. interview with the Director of Nursing revealed the facility does not use consistent staff for obtaining weights, but use different staff and scales to obtain weights. Review of the undated facility policy Weight Monitoring revealed no information related to obtaining re-weighs for significant changes in weights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365152 If continuation sheet Page 7 of 7